Medical Treatment

• Otitis externa

• Most cases are treated with eardrops for 7-10 days.
• These drops contain antibiotic to fight the infection and, sometimes, a steroid to reduce swelling.
• The drops are placed in the ear while the person is lying on his or her side, with the affected ear up.

• The outer ear is gently pulled backwards, and the drops are placed over the opening to the ear canal.
• The ear is gently wiggled for a minute to help the drops penetrate.
• The person should remain in this position at least 5 minutes. Then a cotton ball can be placed over the ear to catch any spill.
• Sometimes a wick is placed in the canal if swelling is severe.
  Some severe cases will require an oral antibiotic as well as the eardrops.
  The person may require strong pain medication for the first few days.
  During treatment and for 1-2 weeks after treatment, water should be kept out of the ear.
• Either an earplug or small cotton ball coated with Vaseline can be used during bathing.
  In some cases the drainage in the ear builds up, and the infection won't clear until it is removed. An otolaryngologist (an ear, nose, and throat specialist), using special equipment, usually will remove this build-up.

• Otitis media

• Most cases are treated with an oral antibiotic for 10-14 days.
• In some cases a decongestant medication is helpful.
• Pain medication may be needed for the first few days.

Follow-up

People with earache caused by ear infection should have follow-up care with their doctors to insure that the infection has completely gone away.

• A follow-up appointment is scheduled 1-3 weeks after starting treatment, depending on the severity of the condition and other factors.
  Take all medications, as prescribed, and finish the prescription, as directed.

NOTE: Ear infections often will return if only partially treated. Do not stop the course of treatment even though symptoms are relieved.

What Is Otitis Media?

Otitis media, sometimes referred to simply as a middle ear infection or inflammation, is the most common cause of earaches. Although this condition is a frequent cause of infant distress and is often associated with children, it can also affect adults.

The infection in the middle ear (where tiny bones pick up vibrations from the eardrum and pass them along to the inner ear) very often accompanies a common cold, the flu, or another type of respiratory infection. This is because the middle ear is connected to the upper respiratory tract by a tiny channel known as a eustachian tube.

Most parents are frustratingly familiar with otitis media. Except for wellness baby visits, ear infections are the most common reason for trips to the pediatrician, accounting for approximately 30 million doctor visits a year in the U.S. Today, almost half of all antibiotic prescriptions written for children are for otitis media, and the cost of treating middle ear infections in the U.S. has been estimated at $2 billion a year. Untreated, otitis media can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, perforation of the eardrum, meningitis, facial nerve paralysis, and possibly Meniere's disease.

What Causes It?

Cells in the middle ear make a fluid that, among other things, help keep out invading organisms. Normally, the fluid drains out through the eustachian tube and into the throat. But if the eustachian tube becomes swollen, the fluid can become trapped in the middle ear, forming a breeding ground for bacteria that can cause the area to become inflamed and infected. This tube lies in a more horizontal position and is shorter in children, which may put them at even greater risk of infection. To the doctor, the eardrum of an infected patient appears red and bulging.

The most common cause of otitis media is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the eustachian tube so swollen that middle ear fluid cannot drain. Allergies - to pollen, dust, animal dander, or food - can produce the same effect, as can smoke, fumes, and other environmental toxins. Bacteria can cause otitis media directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers. Among the bacteria most often found in infected middle ears are the same varieties responsible for many cases of sinusitis, pneumonia and other respiratory infections. (Note: Flu shots do not offer protection from otitis media.)

Otitis media occurs in various degrees of severity. A single, isolated case is called acute otitis media. If the condition clears up but comes back as many as three times in a six-month period (or four times in a single year), it is known as recurrent otitis media. This usually indicates the eustachian tube isn't working right. If it continues for weeks without clearing up, it is called chronic otitis media. A fluid buildup in the ear without infection is termed serous otitis media.

In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections: males; individuals with a family history of ear infections; babies who are bottle-fed (breastfed babies get fewer ear infections); children in day care centers; people living in households with tobacco smokers; and people with poor or damaged immune systems or chronic respiratory diseases such as cystic fibrosis and asthma.

Acute otitis media is usually of rapid onset and short duration. Acute otitis media typically causes fluid accumulation in the middle ear together with signs or symptoms of ear infection; a bulging eardrum usually accompanied by pain, or a perforated eardrum, often with drainage of purulent material (pus). Fever can be present.

Chronic otitis media is a persistent inflammation of the middle ear, typically for a minimum of a month. This is in distinction to an acute ear infection (acute otitis media) that usually lasts only several weeks. Following an acute infection, fluid (an effusion) may remain behind the ear drum (tympanic membrane) for up to 3 months before resolving. Chronic otitis media may develop after a prolonged period of time with fluid (effusion) or negative pressure behind the eardrum (tympanic membrane). Chronic otitis media can cause ongoing damage to the middle ear and eardrum and there may be continuing drainage through a hole in the eardrum. Chronic otitis media often starts painlessly without fever. Ear pressure or popping can be persistent for months. Sometimes a subtle loss of hearing can be due to chronic otitis media.

How common is acute otitis media?

Otitis media is the most common diagnosis in sick children in the U.S. Young children, infants, and preschoolers are particularly prone. Almost every child has at least one bout of acute otitis media before the age of 6.

Why do young children tend to have ear infections?

The Eustachian tube is shorter and more horizontal in young children than in older children and adults. This allows easier entry into the middle ear for the microorganisms that cause infection and lead to otitis media.

What is the Eustachian tube?

The Eustachian tube is a canal that runs from the middle ear to the pharynx (the throat). The function of the Eustachian tube is to protect, aerate and drain the middle ear (and mastoid). Occlusion of the Eustachian tube leads to the development of middle ear inflammation (otitis media).

The Eustachian tube is also called the otopharyngeal tube (because it connects the ear to the pharynx) and the auditory tube (and in Latin, the tuba acustica, tuba auditiva, and tuba auditoria).

The pharynx (throat) is subdivided into 3 parts: the upper part called the nasopharynx, the middle part called the oropharynx, and the lower part called the hypopharynx. The Eustachian tube opens into the nasopharynx.

The shorter length and the horizontality of the Eustachian tube in infancy protects the middle ear poorly, makes for poor drainage of fluid from the middle ear, and predisposes infants and young children to middle ear infection. The greater length and particularly the slope of the tube as it grows serves more effectively to protect, aerate and drain the middle ear.

The Eustachian tube in the adult is opened by two muscles (the tensor palati and the levator palati) but the anatomy of children permits only one of these muscles (the tensor palati) to work.

Why do children with a cleft palate tend to have ear infections?

Ear infections are a particular problem for children born with cleft palate because they have poor function of the tensor palati muscle, the only muscle than can open the Eustachian tube in children. Children with cleft palate therefore suffer from Eustachian tube and middle ear problems until the second muscle (the levator palati) capable of opening the Eustachian tube begins to function.

What microorganisms cause otitis media?

Bacteria and viruses cause otitis media. Bacteria such as Streptococcus pneumoniae (pneumococcus) and Hemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media. Viruses account for the remaining 15%. Affected infants under 6 weeks of age tend to have infections from a variety of different bacteria in the middle ear.

What is the relationship between bottle-feeding and otitis media?

Bottle-feeding is a risk factor for developing otitis media. The position of the breast-feeding child is better than that of the bottle-feeding position in terms of function of the Eustachian tube that leads into the middle ear. If a child needs to be bottle-fed, it is best to hold the infant rather than allow the child to lie down with the bottle. Ideally, the child should not take the bottle to bed. (In addition to increasing the chance for acute otitis media, falling asleep with milk in the mouth enhances the risk of tooth decay.)

Earache

Ear anatomy

Medical findings based on ear anatomy

Alternative names   

Otalgia; Pain - ear

Definition   

Considerations   

Common Causes  

Home Care   
The following steps may help an earache:

• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give aspirin to children .)
• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• Olive oil or over-the-counter ear drops are gentle and effective, as long as the eardrum has not ruptured. Prescription drops, such as Auralgan, are also effective at pain relief.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position may help reduce pressure in the middle ear.

Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help.

Call your health care provider if   

What to expect at your health care provider's office  

Prevention